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Deadline to recoup wrongly paid care fees

Do you have an elderly relative living in care or receiving care in the home? Does their main or primary need for care relate to their health? If so, they may be entitled to NHS Continuing Healthcare, a package of care funded solely by the NHS.

Where a person qualifies for this type of funding, their whole package of care (including their accommodation if necessary) becomes the responsibility of the relevant Primary Care Trust rather than the Local Authority, the individual themselves or a combination of the two. What’s more, NHS Continuing Healthcare is non means tested, so if a person qualifies for it, the full cost of the appropriate care package is likely to be met by the relevant PCT.

Anyone who should have been entitled to this funding, but has instead been paying their own fees, has until 30th September 2012 to appeal the decision of the appropriate Primary Care Trust (for decisions made prior to 31st March 2011). This deadline also applies to the executors of an estate of a person who should have received the funding during their lifetime.

Unfortunately, the diagnosis of a particular disease or condition such as Dementia or Alzheimer’s does not in itself ‘qualify’ a person for NHS Continuing Healthcare and the rules around eligibility are quite complex. Similarly, the care provider (i.e. a registered nurse or GP) is not sufficient alone to determine eligibility and neither is the location of the care (i.e. hospital, nursing home, hospice or the individual’s own home). Further, since many conditions are degenerative, eligibility is also time specific and just because an individual was not eligible at one point in time does not mean that he or she cannot become eligible in the future.

Despite guidelines aiming to assist families through the complexities of assessment, many are unaware that the funding even exists or that a relative has been assessed for it, let alone whether or not he or she should be entitled to it.

Most families will, however, be aware of the rising costs of care, and will appreciate that bringing a successful claim could reimburse their relative a substantial sum.If you feel that your relative’s needs are, or were, primarily healthcare needs and you would like to discuss the possibility of making a claim, make an appointment with one of our team who will be pleased to assist.

This article was prepared by Gemma Dilley who can be contacted on 01582 514307.